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There is concern amongst some geriatricians that conventional academic geriatric posts are withering on the vine1 and that opportunities for funding geriatric research, as opposed to ageing research, are inadequate - see John Gladman’s contribution.

This view is fuelled by concerns that many chairs in geriatric medicine have been ‘lost’ or remain unfilled. Together with concerns about undergraduate geriatric education^2-4, one might be inclined to some despondency about the future of any would be academic geriatricians.

Geriatrics however, is very much alive and kicking, and the UK should be rightly proud of the fact that geriatric medicine is the largest medical speciality. There are, in fact, around 50 geriatricians holding professorial chairs throughout England and Wales, and many geriatricians hold important roles in undergraduate education throughout the country, albeit not necessarily university based posts. Now, more than ever before, geriatrics is the mainstream speciality and this should mean that the UK is well positioned to engage with the forthcoming silver tsunami⁵. So, why then all the pessimism? Part of this is perhaps related to the inherent humility of the geriatrician, but perhaps also a certain unwillingness to stray too far from the beaten track, as laid down by Marjory Warren some 50 years ago.

Geriatricians are no longer seen as second class physicians, but are becoming increasingly valued for their generalist approach and ability to mange complex patients, whether in acute care settings, rehabilitation settings, in end of life care and other scenarios both in primary and secondary care. Few other specialities can bring such breadth of knowledge and skills to their patients. How many specialties can quote multiple RCTs and a series of meta-analyses^6,7 in support of their raison d’être (comprehensive geriatric assessment)? Teaching of the geriatric giants is now commonplace on most medical school curricula. Several geriatricians have leading roles in the Royal College of Physicians and the Department of Health as well as other august bodies. In terms of research, ageing is now one of the top three priority areas for the Medical Research Council, and the rationalisation of NHS funding should lead to a greater focus of research on priority areas for the NHS – of which ageing and frailty is surely one.

Humble geriatricians
So perhaps it is a glass half-full/half-empty scenario? Geriatricians remain, on the whole, inherently humble and down to earth, and are not by nature egoistical and glory seeking, which are some of the hallmarks of the more vociferous ‘successful’ academics. So whilst we do not shout about the speciality from the rooftops, academic and clinical agendas are being subtly influenced for the good of frail older people.

So what then of the academic geriatricians of old?
Well, I suspect that the role of the forefathers of geriatric medicine has been fulfilled. Geriatrics is now mainstream. The academic geriatrician of today needs to find his or her niche elsewhere. And there are plenty of challenges – care home medicine⁸, community geriatrics⁹, acute care¹⁰, end of life care¹¹ and frailty¹² are just a few of the many areas ripe for exploitation by academic geriatricians. Geriatricians are well placed to lead or support such research, because of their broad and multi-dimensional knowledge, and their natural inclination for collaborative and interdisciplinary working.

So maybe the labels are different, and the landscape is changing, but the role for a researcher in areas relevant to geriatric medicine is great. Geriatricians just need to have confidence to embrace new ways of branding the speciality. This does not mean changing name – one of which we should be proud given the heritage, but being prepared to work with different groups in different ways. Stroke medicine is a good example of what can be achieved – massive service improvement driven by research.

Why does any of this matter to the ‘jobbing geriatrician’? After all, academic geriatricians are few and far between, and most people are just getting on with the job in hand. Well in my view, one of the key roles of the academic is to enhance the reputation of a department, whether through service development, teaching, research – or better still, all three. We need to make geriatrics appealing, such that it attracts junior doctors at an early stage, rather than later on in their training once they realise that medicine is about people and not procedures, as has traditionally been the case¹³. That is about role models, and the role of geriatricians to speak up for the speciality and all the challenges – and opportunities, that it brings. The academic geriatrician – all geriatricians - should be leading role models, expounding the virtues of a career in geriatric medicine, ensuring that the brightest and best trainees are attracted to a stimulating and vibrant speciality. Part of this is related to the academic esteem of a speciality, the impetus that research brings to clinical service delivery and this is why academic geriatrics should be supported.

Simon Conroy
Senior Lecturer and Geriatrician
Leicester Medical School

References
1. Jackson S. BGS Academic and Research Strategy 2004.

2. Bartram L, Crome, P., McGrath, A., Corrado, O.J., Allen, S.C., Crome, I,. Survey of training in geriatric medicine in UK undergraduate medical schools. Age & Ageing 2006(35):533-5.

3. Fletcher P. Will undergraduate geriatric medicine survive? Age & Ageing 2007(36):358-60.

4. Lally FC, P,. Undergraduate training in geriatric medicine: getting it right. Age & Ageing 2007(36):366-8.

5. Linda P. Fried WJH. EDITORIAL: Leading on Behalf of an Aging Society. Journal of the American Geriatrics Society 2008;56(10):1791-1795.

6. Stuck AE, Siu AL, Wieland GD, Rubenstein LZ, Adams J. Comprehensive geriatric assessment: a meta-analysis of controlled trials. The Lancet 1993;342(8878):1032.

7. G Ellis PL. Comprehensive geriatric assessment for older hospital patients systematic review and meta-analysis. British Medical Bulletin 2005(71):1.

8. Donald IP, Gladman J, Conroy S, Vernon M, Kendrick E, Burns E. Care home medicine in the UK--in from the cold. Age Ageing 2008:afn207.

9. Gladman J, Donald I, Archard G, Morris J. Interface between primary and secondary medical care in the new NHS in England : the care of frail older people by GPs and consultant geriatricians, 2007.

10. Conroy S. Emergency room geriatric assessment--urgent, important or both? Age Ageing 2008:afn215.

11. Conroy S FP, Fraser A, Schiff R,. Advance care planning: concise evidence-based guidelines. In: Turner-Stokes L, editor. Concise Guidance to Good Practice series. London: RCP, 2009.

12. Fried LP, Hadley EC, Walston JD, Newman AB, Guralnik JM, Studenski S, et al. From Bedside to Bench: Research Agenda for Frailty. Sci. Aging Knowl. Environ. 2005;2005(31):pe24-.

13. Briggs S AR, Playfer J, Corrado O,. Why do doctors choose a career in geriatric medicine? Clin Med 2006(6):469-72.

BGS Newsletter, March 2009
Issue 20 ISSN 1748-6343 20